MEDICARE: DR. SALLYE S. SCOTT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	472	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497783864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLYE S. SCOTT OD

Provider Business Mailing Address
First Line	:	PO BOX 385
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-0385
Country	:	US
Telephone Number	:	662-487-1316
Fax Number	:	662-487-9270

Provider Business Practice Location Address
First Line	:	119 S MAIN STREET
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666
Country	:	US
Telephone Number	:	662-487-1316
Fax Number	:	662-487-9270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/31/2008

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